When you have ADHD or ADD having Rejection Sensitive Dysphoria can mean that you suffer from huge emotional challenges. Pain, sensitivity, and other challenges relating to mood can occur. This problem can directly imitate mood issues that often show symptoms like suicide ideation, and can cause impactful rage events directed at anybody we blame for causing us pain. 

Rejection Sensitive Dysphoria - What Is It? 

RSD is when we are extremely emotionally sensitive and suffer pain at the idea that we have been wronged in some way by important people we know. It can even occur when we think we are not achieving in the way we think we should be achieving. We may feel we do not meet the high expectations of anybody, including ourselves. 

Dysphoria means ‘difficult to bear’ in Greek, which means that it isn’t about a person with ADHD being weak, or is that the emotions they feel cause them so much more pain than those without ADHD. Of course, nobody wants to experience rejection, failure, or criticism. If you have Rejection Sensitive Dysphoria though, those experiences are much bigger, much more challenging, and much more severe than in those without the condition. They can impact your life quality and impair your ability to live well. 

When you keep these emotions inside, an entire mood disorder and the suicidal ideation that comes with it can be imitated. The quick change from feeling OK, to feeling really sad, is common with Rejection Sensitive Dysphoria and is often misdiagnosed as RCMD (rapid cycling mood disorder). 

It can take a while for doctors to see that these symptoms are caused by ADHD and RSD, while other ways of relating to other people appear to be normal. RSD is, in fact, very common with ADHD, especially in those aged over 18. 

When the emotional response associated with RSD is externalized, it tends to look like a huge amount of rage that has come from nowhere, expressed towards whatever, or whoever has caused the pain. This response is so prevalent many people who have been made to do anger-management courses by the legal system have undiagnosed ADHD. 

RSD can make those with ADHD prepare for rejection, even when rejection may not happen. It can make a person work hard to avoid it happening, which can then translate as a social anxiety disorder misdiagnosis. Social anxiety tends to revolve around a fear of humiliating yourself in front of others, or that you will be criticized by others. You anticipate these things happening, even though there is no guarantee they will happen. 

Often the condition is difficult to comprehend, with its many layers. A person may struggle to explain how it feels. Words like ‘extreme, painful, awful, and overwhelming’ may be used. It always stems from the idea that you will lose, or have lost, approval, respect, or even love. 

Those with ADHD tend to deal with this emotional problem in two ways, which don’t always happen together: 

1. Constantly Working To Please Others

With RSD a person may work overtime to please others. Every single person they meet they will analyze to find out what the person loves, and offers praise for. The person with RSD may then present themselves in a way that fits the desired profile of the person they want to impress. This can be such an overwhelming feature of their lives that they may forget about their own goals. They focus more on how to ensure everybody they know approves of them. 

2. No More Trying

A person with RSD may stop trying because failing or falling short in front of anybody at all, is too much of a risk. A person may be intelligent, talented, funny, and attractive, and yet they are too anxious to date, work, or even speak socially or professionally. 

Some people with RSD may use the emotional pain they have to adapt and achieve lots. They may work hard constantly, exhausting themselves to do their very best and reach a level of perfection that is unachievable. They may be widely admired by others, but at a huge cost to their own personal wellbeing. 

Getting Over RSD - Is It Possible?

Rejection Sensitivity Disorder is intrinsically linked to ADHD. It is part of the way an ADHD brain works and tends to run in the family genes. Trauma experienced in childhood can exacerbate the issue, but it won’t directly cause the disorder. Commonly, a patient experiencing the disorder is pleased to have a diagnosis and a label for what they are going through. To know they are not alone and that most people with ADHD are experiencing, or experience, rejection sensitivity. After getting the diagnosis they can feel validated, knowing that the way they feel is not their fault and that they are not the cause of their problems. 

In most instances, psychotherapy is not very helpful if you have RSD because the emotions that occur can come on extremely suddenly and feel overwhelming at that time. After this has happened, it may take a while for that person to get back to their version of normal. 

There are, however, some medication options if you have RSD. 

The easiest solution is an alpha agonist such as guanfacine or clonidine which can be prescribed by your doctor. They are blood pressure medications and come in various dosage options. Some people get relief from this medication when it comes to their RSD, and if they do, it can give them a tremendous quality of life. Sometimes, this treatment can be even more effective than an ADHD stimulant drug, although those medications can be incredibly effective for some. 

Another drug type is monoamine oxidase inhibitors which is a common treatment of choice for RSD. This can be effective for ADHD impulsivity symptoms as well as emotional symptoms. Parnate (tranylcypromine) tends to work well offering the fewest side effects which can be; drowsiness, confusion, feeling agitated, and suffering from low blood pressure. 

MAOIs were found to work just as well for ADHD as methylphenidate in early trials, producing a small number of side effects when taken once a day. They are also low in cost and are approved by the FDA for anxiety and mood conditions. The issue with them is that certain foods have to be avoided when you take them, such as aged food. You also have to avoid certain anesthesia types, cough medicines, sinus medicines, ADHD stimulant medicines, and depression medication - to name just a few.